Woo Han, Brigham Emily P, Allbright Kassandra, Ejike Chinedu, Galiatsatos Panagis, Jones Miranda R, Oates Gabriela R, Krishnan Jerry A, Cooper Christopher B, Kanner Richard E, Bowler Russell P, Hoffman Eric A, Comellas Alejandro P, Criner Gerard, Barr R Graham, Martinez Fernando J, Han MeiLan, Ortega Victor E, Parekh Trisha M, Christenson Stephanie, Belz Daniel, Raju Sarath, Gassett Amanda, Paulin Laura M, Putcha Nirupama, Kaufman Joel D, Hansel Nadia N
Division of Pulmonary and Critical Care Medicine and.
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Am J Respir Crit Care Med. 2021 Sep 1;204(5):536-545. doi: 10.1164/rccm.202009-3721OC.
Racial residential segregation has been associated with worse health outcomes, but the link with chronic obstructive pulmonary disease (COPD) morbidity has not been established. To investigate whether racial residential segregation is associated with COPD morbidity among urban Black adults with or at risk of COPD. Racial residential segregation was assessed using isolation index, based on 2010 decennial census and baseline address, for Black former and current smokers in the multicenter SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study), a study of adults with or at risk for COPD. We tested the association between isolation index and respiratory symptoms, physiologic outcomes, imaging parameters, and exacerbation risk among urban Black residents, adjusting for established COPD risk factors, including smoking. Additional mediation analyses were conducted for factors that could lie on the pathway between segregation and COPD outcomes, including individual and neighborhood socioeconomic status, comorbidity burden, depression/anxiety, and ambient pollution. Among 515 Black participants, those residing in segregated neighborhoods (i.e., isolation index ⩾0.6) had worse COPD Assessment Test score (β = 2.4; 95% confidence interval [CI], 0.7 to 4.0), dyspnea (modified Medical Research Council scale; β = 0.29; 95% CI, 0.10 to 0.47), quality of life (St. George's Respiratory Questionnaire; β = 6.1; 95% CI, 2.3 to 9.9), and cough and sputum (β = 0.8; 95% CI, 0.1 to 1.5); lower FEV% predicted (β = -7.3; 95% CI, -10.9 to -3.6); higher rate of any and severe exacerbations; and higher percentage emphysema (β = 2.3; 95% CI, 0.7 to 3.9) and air trapping (β = 3.8; 95% CI, 0.6 to 7.1). Adverse associations attenuated with adjustment for potential mediators but remained robust for several outcomes, including dyspnea, FEV% predicted, percentage emphysema, and air trapping. Racial residential segregation was adversely associated with COPD morbidity among urban Black participants and supports the hypothesis that racial segregation plays a role in explaining health inequities affecting Black communities.
种族居住隔离与更差的健康结果相关，但与慢性阻塞性肺疾病（COPD）发病率之间的联系尚未确立。为了调查种族居住隔离是否与患有COPD或有COPD风险的城市黑人成年人的COPD发病率相关。在多中心SPIROMICS（慢性阻塞性肺疾病研究中的亚人群和中间结局指标）研究中，基于2010年十年一次的人口普查和基线地址，使用隔离指数对黑人既往和当前吸烟者的种族居住隔离情况进行评估，该研究针对患有COPD或有COPD风险的成年人。我们测试了隔离指数与城市黑人居民的呼吸道症状、生理结局、影像学参数和加重风险之间的关联，并对已确定的COPD风险因素（包括吸烟）进行了调整。针对可能处于隔离与COPD结局之间路径上的因素进行了额外的中介分析，这些因素包括个人和邻里的社会经济地位、合并症负担、抑郁/焦虑以及环境污染。在515名黑人参与者中，居住在隔离社区（即隔离指数⩾0.6）的人具有更差的COPD评估测试得分（β = 2.4；95%置信区间[CI]，0.7至4.0）、呼吸困难（改良医学研究委员会量表；β = 0.29；95%CI，0.10至0.47）、生活质量（圣乔治呼吸问卷；β = 6.1；95%CI，2.3至9.9）以及咳嗽和咳痰（β = 0.8；95%CI，0.1至1.5）；预测的FEV%更低（β = -7.3；95%CI，-10.9至-3.6）；任何加重和严重加重的发生率更高；肺气肿百分比更高（β = 2.3；95%CI，0.7至3.9）以及气体潴留更高（β = 3.8；95%CI，0.6至7.1）。对潜在中介因素进行调整后，不良关联有所减弱，但对包括呼吸困难、预测的FEV%、肺气肿百分比和气体潴留在内的几个结局仍保持显著。种族居住隔离与城市黑人参与者的COPD发病率呈负相关，并支持种族隔离在解释影响黑人社区的健康不平等方面发挥作用这一假设。
